Lower urinary tract dysfunction (LUTD) includes symptoms related to bladder storage, emptying, pain, and infection. LUTD is a highly prevalent chronic medical condition that disproportionately affects women and contributes to overall morbidity. Based on population growth and prevalence estimates, lower urinary tract symptoms (LUTS) and conditions are expected to affect more than 43 million women over the next 30 years. The cost to society for LUTS and related issues such as falls and lost productivity is estimated to be over $65 billion per year. LUTS also interfere with participation in social and physical activities, which affects quality of life and also contributes negatively to other chronic medical conditions such as cardiovascular disease, diabetes, obesity, and depression. Clearly, there is high individual and societal impact, however many women do not understand these implications, and even symptomatic women often don't seek treatment. This is likely due to a focus on disease treatment without adequate understanding of what behaviors affect LUTS development and progression. The PLUS consortium will establish the evidence base necessary to conduct future prevention intervention studies in girls and women. The objective of our application is to demonstrate how we can build the knowledge base for bladder health using Ecological Systems Theory as a guiding framework, an approach that addresses risk factors at the individual, family/peer, and community levels. Health outcomes are affected by a variety of complex and interrelated factors both at the individual and environmental level. The majority of current evidence for bladder health and risk factors for LUTS is based on individual traits, and therefore most interventions have focused on a single stratum of the ecologic model without consideration of contextual targets within other levels. Utilizing existing databases, focus groups, and longitudinal cohort studies, we will consider issues including biologic factors, behaviors, knowledge, environment, and health services that will determine who is at risk to develop LUTS and how early symptoms are addressed and managed. A multi-level approach is essential to any sustainable, effective program; hence, an ecological framework that accounts for multiple contextual factors is critical to identifying and ultimately changing behaviors that lad to LUTS and associated health outcomes. The multidisciplinary team we have assembled for the Yale Bladder Health Clinical Center includes experts in LUTS care and research in addition to investigators with expertise in health behaviors and epidemiologic studies across the age range of females including smoking, vaccination, obesity, prenatal care, urinary tract infection, and disability. Investigators have recruited female patients both from primary care clinics and the community into numerous longitudinal studies, and their approach to chronic disease prevention will shed new light on the study of risk and protective factors for LUTS. This innovative collaboration between clinicians and prevention scientists will help redefine LUTS as a public health issue and ultimately improve the long term health and wellness of millions of girls and women.